Comparison of Three Measures of Shared Decision Making: SDM Process_4, CollaboRATE, and SURE Scales

Abstract

Objective. If shared decision making (SDM) is to be part of quality assessment, it is necessary to have good measures of SDM. The purpose of this study is to compare the psychometric performance of 3 short patient-reported measures of SDM. Methods. Patients who met with a specialist to discuss possible surgery for hip or knee osteoarthritis (hips/knees), lumbar herniated disc, or lumbar spinal stenosis (backs) were surveyed shortly after the visit and again 6 months later. Some of the patients saw a patient decision aid (PDA) prior to the meeting. The 3 SDM measures were the SDM Process_4 (SDMP) survey, CollaboRATE, and SURE scale. The follow-up survey included measures of decision regret, satisfaction, and decision quality. Results. Patients in the sample ( N = 649) had a mean age of 63.3 years, 51% were female, 60% were college educated, and there were more hip/knee patients than back patients (69% v. 31%). Forty-nine percent had surgery. For hips/knees, the SDMP and SURE scores were significantly associated with viewing all of the PDA compared with those who did not ( P < 0.001), but not for CollaboRATE ( P = 0.35). For backs, none of the scores were significantly associated with viewing all the PDA. All 3 scores were significantly associated with less regret and higher satisfaction ( P < 0.001) for hips/knees. For backs, only SURE and CollaboRATE were significantly associated with less regret, and only SDMP was significantly associated with higher satisfaction. For hips/knees and backs, the SDMP and SURE scales were significantly associated with an informed patient-centered decision ( P < 0.001), but this relationship was not significant for CollaboRATE (hips/knees: P = 0.24; backs: P = 0.25). Discussion. Each measure has some evidence of validity. SURE and SDMP better discriminate the use of PDAs and have higher decision quality.

Five Golden Rings to Measure Patient‐Centered Care in Rheumatology

“…For predictive validity, SURE was associated with less regret and higher satisfaction for hip/knee surgery patients . For construct validity, patients who made informed patient‐centered decision had higher a SURE score .…”

“…For discriminant validity, the SURE score was significantly associated with having read or viewed the entire patient decision aid for hip/knee surgery compared with having viewed none or only some of the decision aid . For predictive validity, SURE was associated with less regret and higher satisfaction for hip/knee surgery patients . For construct validity, patients who made informed patient‐centered decision had higher a SURE score .…”

“…In primary care cohorts, up to 85% of participants scored 4 of 4 . Another study found that only 53% of patients considering back surgery scored 4 of 4 .…”

“…Brodney et al assessed discriminant, predictive, and construct validity of SURE in a rheumatology population of 649 patients considering hip/knee surgery for osteoarthritis or surgery for back pain. For discriminant validity, the SURE score was significantly associated with having read or viewed the entire patient decision aid for hip/knee surgery compared with having viewed none or only some of the decision aid . For predictive validity, SURE was associated with less regret and higher satisfaction for hip/knee surgery patients .…”

Validation of the 3-item What Engagement Looks Like (WELL) scale in patients with diabetes

“…There is a growing body of evidence describing how to measure SDM and assess the quality of a preferencesensitive medical decision [10][11][12][13], but the majority of those studies focus on measuring SDM for major onetime decisions, such as surgical decisions, not ongoing decisions about how to manage chronic conditions. There are differences in how patients engage in SDM for a one-time decision compared to how they manage a chronic condition that includes initiating and sustaining a behavior change [14].…”